For better or for worse? The effects of alcohol use on marital functioning

Abstract

Two competing hypotheses propose opposite effects for the relation between alcohol use and marital functioning. One hypothesis conceptualizes alcohol use as maladaptive and proposes that it serves as a chronic stressor that causes marital dysfunction and subsequent dissolution. An opposing hypothesis proposes that alcohol use is adaptive and serves to temporarily relieve stressors that cause marital dysfunction, stabilizing the marital relationship, and perhaps preventing dissolution. Sixty studies were reviewed that tested the relation between alcohol use and one of three marital functioning domains (satisfaction, interaction, and violence). Results provide overwhelming support for the notion that alcohol use is maladaptive, and that it is associated with dissatisfaction, negative marital interaction patterns, and higher levels of marital violence. A small subset of studies found that light drinking patterns are associated with adaptive marital functioning; however, more research is necessary to replicate these effects and identify specific conditions under which they occur.

Introduction

The term alcoholic marriage McCrady & Epstein, 1995a, McCrady & Epstein, 1995b, Paolino & McCrady, 1977 is often used to describe a partnership in which one or both of the partners have a history of alcoholism that interferes with successful, day-to-day marital functioning. Although alcoholic marriages are fairly common in the United States, with estimated prevalence rates ranging anywhere from 10% to 45% (Clark & Hilton, 1991), the commencement and subsequent trajectory of the alcoholic marriage is anything but common. For example, a recent review of what has been termed alcohol and the marriage effect concluded that (a) alcoholics are less likely to get married than are nonalcoholics, (b) if they do get married, it is often earlier or later in the young-adult developmental cycle than nonalcoholics, (c) alcoholics are likely to reduce alcohol use once they are married, and (d) they are more likely to get divorced than are nonalcoholics (Leonard & Rothbard, 1999).

This last finding, that alcoholics are more likely to get divorced than are nonalcoholics, is consistent with the most intuitive and popular hypothesis regarding this relationship, that alcohol use serves as a chronic stressor, and has a deleterious influence on marital functioning (for reviews, see Gotlib & McCabe, 1990, Halford et al., 1999, O'Farrell & Rotunda, 1997). Indeed, social exchange theory (see McCrady, 1982) posits that alcohol use causes stressful family interactions, the negative effects of which are dampened by subsequent alcohol use, thereby serving as a negative reinforcer. As alcohol use increases, then, so do negative family interactions, marital violence, and marital dissatisfaction, all of which serve to perpetuate the dissolution process (Gottman, 1994).

Another popular hypothesis, originating from a family systems approach to alcoholism, suggests that alcohol use serves an adaptive function in the marital relationship rather than a maladaptive one (see Steinglass & Robertson, 1983, for review). The basic tenets of this theory contend that family interaction patterns serve to maintain alcohol use, by rewarding drinking behaviors through subsequent family interactions that serve as positive reinforcers. The seminal work of Steinglass and colleagues provides some qualitative evidence in support of this process. For example, they observed alcoholic family interaction (marital dyads, with and without children) in the hospital, laboratory, and at home, and concluded that alcohol use temporarily relieves daily stress or tension in the family system through increases in affective expression and problem-solving ability, helping to maintain relatively stable and adaptive marital and family relationships Steinglass, 1971, Steinglass, 1979a, Steinglass, 1979b, Steinglass et al., 1977. This hypothesis is provocative not only because it suggests that drinking behavior is maintained by family interactions, but that a relatively successful marital relationship might be maintained by alcohol use.

These contradictory hypotheses—one predicting maladaptive marital outcomes and the other predicting adaptive marital outcomes—are important because they have guided several decades of research on the effects of alcohol use on marital functioning. This research has posed and tested three main questions: (a) Do alcoholic marriages differ from nonalcoholic marriages in their quality of marital functioning? (b) Is alcohol consumption related to marital functioning? (c) What theoretical and methodological factors moderate the relation between alcohol consumption and marital functioning? The primary goal of this review was to evaluate the nature of the relation between alcohol use and marital functioning (adaptive versus maladaptive) using these questions. The secondary goal of this review was to evaluate and summarize the methodological strengths and weaknesses of this literature and the extent to which they inform us about the internal and external validity of the findings, and our ability to make causal inferences regarding the relationship between alcohol use and marital functioning.

Marital functioning outcome variables used with intact couples are typically operationalized as marital satisfaction, interaction, and violence. Although some researchers have provided fairly extensive reviews within one marital functioning domain (e.g., Jacob & Seilhamer, 1987, Leonard, 1993, McCrady & Epstein, 1995a, McCrady & Epstein, 1995b), a comprehensive review that includes all three marital functioning domains has not been written. There are two main reasons why a review of this nature is important. First, a comprehensive review of the empirical literature that has evaluated the effects of alcohol use on multiple indices marital functioning is a necessary first step towards understanding their role in the association between alcohol and marital success and/or marital dissolution and divorce. Second, it can highlight similarities and differences in the methods, results, and conclusions of these studies across three frequently used marital functioning domains, which have been studied relatively independently of one another in the alcohol use literature. Indeed, one of the strengths of an integrative review is that it can compare and contrast the conclusions from studies that have inherently different design methodologies. For example, marital interaction research involves the microanalysis of moment-to-moment behaviors of each spouse during a dyadic interaction task in the laboratory, whereas violence research typically evaluates the effects of concurrent, self-reported predictors and moderators of verbal and physical aggression. Because evaluating the adaptive and maladaptive associations between alcohol use and marital functioning involves integrating the conclusions of these disparate methodologies, a qualitative rather than quantitative review of this literature was conducted.

Several search methods were employed to identify studies in the literature that tested the relation between alcohol and marital functioning in intact, married couples. The primary search engine/database employed was PsychInfo, which identified well over 1000 articles and book chapters using several variations of the keywords alcohol and marriage. Alcohol was also used in combination with several marital functioning keywords such as satisfaction, interaction, communication, conflict, violence, and aggression to identify relevant studies. These abstracts were then evaluated to determine whether the study tested the relation between alcohol and marital functioning. The second stage of the search procedure involved identifying key alcohol and marital functioning measures and using the Social Science Citation Index to identify articles that cited them. These abstracts were also evaluated to determine if they met criteria for the current review. Finally, articles were located using the bibliographies of all articles that tested the relation between alcohol and marital functioning. Altogether, 60 peer-reviewed articles and book chapters were identified using these procedures, which tested 70 outcomes (24 satisfaction, 16 interaction, and 30 violence) using 44 independent samples. Because the majority of these studies were quasi-experimental, an evaluation of the internal and external validity of the results and our ability to make causal inferences about this relation rely heavily on study design characteristics including: sampling procedures, sample size, demographic characteristics, inclusion/exclusion criteria, data analytic strategies, and the construct validity of the alcohol and marital functioning variables. A summary of these characteristics and their implications as they pertain to this literature, therefore, will be discussed prior to summarizing the results. A detailed description of the methodological characteristics of all studies cited in this review is presented in Table 1. The information contained in this table was used as a vehicle for describing and summarizing the methodological characteristics of each subset of studies, and as a result, is divided into three parts. Table 1A contains all studies that tested the relationship between alcohol and marital satisfaction, Table 1B contains all marital interaction studies, and Table 1C contains all marital violence studies. Each part is alphabetically ordered by the last name of the first author.